Healthcare Provider Details

I. General information

NPI: 1780176172
Provider Name (Legal Business Name): RP ACUPUNCTURE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

397 PALM COAST PKWY SW UNIT 4
PALM COAST FL
32137-4777
US

IV. Provider business mailing address

397 PALM COAST PKWY SW UNIT 5
PALM COAST FL
32137-4777
US

V. Phone/Fax

Practice location:
  • Phone: 386-447-0610
  • Fax: 386-447-0670
Mailing address:
  • Phone: 386-447-0610
  • Fax: 386-447-0670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number3945
License Number StateFL

VIII. Authorized Official

Name: ROSA PANOS
Title or Position: OWNER
Credential: PT, AP, DIPL. OM
Phone: 386-447-0610